Thanks in part to Karl Menninger’s writing, hope has long been prominent in thinking about treatment at The Menninger Clinic.

Inspired by this tradition, my colleagues and I have incorporated hope into patient educational groups for many years. In these group sessions, we start with a general discussion about our understanding of hope.

After the general discussion, we routinely ask each individual, “What gives you hope?” We write all the answers on a big white board and use them to expand our initial discussion.

My rationale for patient education comes from Aristotle, who asserted that we are more likely to achieve our aim when we have a target. Thus, to cultivate hope, we must first aim to understand what it involves. Here are some common themes:

Hope entails positive expectations for the future, a vision of a better future.

Hope emerges in the context of uncertainty and unpredictability.

Hope is needed in dire or tragic situations, not when all is going well.

Arising in dire situations, hope is intertwined with fear, doubt and despair; without these, hope would not be needed.

Oscillating with fear, doubt and despair, hope is not established once and for all; it is a project.

Hope requires facing reality; the positive expectations for the future must be sound and reasonable.

Wishful thinking can be a diversion from hope, an inclination to escape reality.

Unlike wishful thinking, which is passive, hope is active, requiring effort to bring about positive expectations.

Sometimes you must rely on borrowed hope, that is, the hope that others have for you and which you are unable to have for yourself.

For many persons, hope is rooted in faith and spirituality.

Hope vs. depression

Depression is the enemy of hope, potentially robbing sufferers of any positive feeling or vision for the future. Notoriously, depression is associated with hopelessness.

In my view, hopelessness entails an unreasonable sense of certainty: The future will turn out badly. My favorite response to the question, “What gives you hope?” was this: “I can be surprised!”

Hopelessness is one reason that many depressed persons must rely on borrowed hope. There are many potential lenders of hope, and patients most often respond to our question (What gives you hope?) by referring to family members and other loved ones.

Other factors in hopelessness

Along with depression, isolation and alienation play a major role in hopelessness. Establishing hope commonly requires reestablishing a sense of connection and belonging. Karl Menninger’s colleague and my mentor, Paul Pruyser, emphasized connection in his inspiring view of hope as based on a belief that there is some benevolent disposition toward yourself somewhere in the universe, conveyed by a caring person.

I love the open-endedness of this view of hope, which allows for spiritual as well as human connections. Pruyser’s reference to a caring person brings in the fundamental human need for attachment and the feeling of security that is essential to our wellbeing – from the cradle to the grave, as John Bowlby put it. It is little wonder that Karl Menninger homed in on the centrality of hope in conjunction with treatment at The Menninger Clinic.

Many patients who seek treatment at The Clinic struggle to maintain hope, and they need foremost to reestablish a sense of connection. Pruyser was right on the mark: They need a sense of a benevolent disposition directed toward them, conveyed by caring persons. This need is evident in all forms of psychiatric treatment, but especially so in the frequently dire circumstances that lead patients to seek intensive inpatient treatment.

Editor’s note: Don’t forget to check out some of Dr. Allen’s other blog posts:

At its core, the driving force behind the concept of the superhero is hope. It’s about underdogs (with ridiculous, over-the-top powers and costumes, of course) beating a larger, deadlier foe in the nick of time. It’s about good always triumphing over evil, no matter the odds. It’s about believing that a better, safer world is right around the corner.

And so it’s no surprise that someone would use this trope to talk about mental health. In the video below, Laura Burke uses the idea of the superhero to frame her spoken-word poem about coping with her own mental illness. There are no explosions, no people flying around wearing their underwear on the outside of their clothes and there are no climactic battles in the “visual poem” she created with the people at the Mental Health Foundation of Nova Scotia. Instead, there is a simple moving message: Those struggling with a mental illness don’t have to be ruled by it.

Phil is a Navy veteran I met during a visit to The Gathering Place, a psychosocial clubhouse for individuals who are managing a mental illness. When I introduced myself as a fellow veteran, Phil asked, “What branch of the military?”

I said, “Army.” He said, “Too bad!”

We bonded immediately.

The folks at this particular clubhouse suffer a range of disorders that include schizophrenia, schizoaffective disorder, bipolar disorder and depression.

In Phil’s case, three separate aneurysms followed by depression tore his life apart. The physical damage erased his personality and played havoc with his memory. Over time he lost his white collar job, his home and was divorced, losing his family, which included several children.

Struggling to cope with the effects of brain damage and depression, he became homeless for several years, living where he could, which included a garage with several other men in similar circumstances.

According to the Veterans Administration, “Homeless veterans tend to be older and more educated than homeless non-veterans. But similar to the general population of homeless adult males, about 45 percent of homeless veterans suffer from mental illness and (with considerable overlap) slightly more than 70 percent suffer from alcohol or other drug abuse problems. Roughly 56 percent are African-American or Hispanic.”

The Gathering Place, a service of The Menninger Clinic

After finding his clubhouse, meeting people with similar difficulties and receiving some basic social services, Phil began to recover a sense of himself. Over time, he learned skills that allowed him to oversee the clubhouse canteen and to operate a cash register. He acquired friends, even a girlfriend, and began to rent his own apartment, leaving the garage behind.

The new Phil will never be as healthy as the old Phil, but he is involved in his life now, independent and able to wisecrack to strangers through his physical and mental ailments, to appreciate humor and accounting and romance. Access to social services, self-motivation and good guidance from his psychosocial healthcare providers gave him the confidence to weather his circumstances and head in a new and healthier direction.

I don’t know how long it was that Phil wandered around before he realized he could participate again in his own life. I’m happy for him that he is no longer out there or on a corner or in a garage. Veterans don’t deserve that lack of attention. Then again, no one does.

This is about looking into Phil’s face and seeing hope look back. It’s a beautiful sight.